Glycemic Markers and Subclinical Cardiovascular Disease: The Jackson Heart Study

2019 ◽  
Vol 12 (3) ◽  
Author(s):  
Justin B. Echouffo-Tcheugui ◽  
Haiying Chen ◽  
Rita R. Kalyani ◽  
Mario Sims ◽  
Sean Simpson ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Jackson Heart Study ◽  
Heart Study ◽  
Subclinical Cardiovascular Disease ◽  
Glycemic Markers

Abstract P159: Coronary Artery Calcium Score Improves the Net Reclassification Index of Prevalent Cardiovascular Disease In African Americans: The Jackson Heart Study

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Joseph Yeboah ◽  
Che L Smith ◽  
Mario Sims ◽  
Ervin Fox ◽  
Yaorong Ge ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Coronary Artery ◽  
High Risk ◽  
African Americans ◽  
Diagnostic Accuracy ◽  
Coronary Artery Calcium ◽  
Smoking Status ◽  
Jackson Heart Study ◽  
Net Reclassification Improvement ◽  
Heart Study

Background: Prior studies suggest that African Americans (AA) have lower prevalence of coronary artery calcium (CAC) compared to whites, yet CAC has similar ability to predict coronary heart disease (CHD) events. The role of CAC as a screening tool for CHD risk in AA is unclear. We compared the diagnostic accuracy for CHD prevalence using the CAC score and the Framingham Risk Score (FRS) in an adult population of AA. Methods: CAC was measured in 2944 participants in the Jackson Heart Study, an NHLBI funded study of AA based in Jackson, MS. Approximately 8% of this cohort had known cardiovascular disease (CVD) defined as prior MI, angina, stroke, PTCA, CABG or PVD. Logistic regression, ROC and net reclassification index (NRI) analysis were used adjusting for age, gender, SBP, total and HDL cholesterol, smoking status, DM and BMI. FRS was calculated and those with DM were classified as high risk. Results: The mean age was 60, 65% were females, 26% had DM, 50% were obese and 30% were current or former smokers. Prevalent CVD was associated with older age, higher SBP, lower HDL and total cholesterol, and higher CAC. CAC was independently associated with prevalent CVD in our multivariable model [OR (95% CI): 1.26 (1.17, 1.35), p< 0.0001]. In ROC analysis, CAC improved the diagnostic accuracy (c statistic) of the FRS from 0.617 to 0.757 (p < 0.0001) for prevalent CVD. The FRS classified 30% of the cohort as high risk, 38.5% as intermediate risk and 31.5% as low risk. FRS classfied 51% of subjects with prevalent CVD as high risk. Addition of CAC to FRS resulted in net reclassification improvement of 4% for subjects with known CVD and 28.5% in those without CVD (see figure). Conclusion: In AA, the CAC is independently associated with prevalent CVD and improves the diagnostic accuracy of FRS for prevalent CVD by 14%. Addition of CAC improves the NRI of those with prevalent CVD by 4% and the NRI of individuals without CVD by 28.5%. Determination of CAC in AA may be useful in identifying individuals at risk of CVD and reclassifying individuals with low and intermediate FRS.

Abstract P012: Hypertension and Alterations in Left Ventricular Geometry in African Americans: The Jackson Heart Study

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Marwah Abdalla ◽  
John N Booth ◽  
Keith M Diaz ◽  
Mario Sims ◽  
Paul Muntner ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
African Americans ◽  
Left Ventricular ◽  
Left Ventricular Geometry ◽  
Jackson Heart Study ◽  
Antihypertensive Medications ◽  
Geometric Patterns ◽  
Ventricular Geometry ◽  
Disease Outcomes ◽  
Heart Study

Introduction: Compared with whites, African Americans (AAs) have a higher risk for hypertension-related cardiovascular disease outcomes, which may be related to alterations in left ventricular geometry. Scarce data exist on how the left ventricle remodels in response to hypertension among AAs. Hypothesis: We hypothesized that among AAs, hypertension will be associated with abnormal echocardiographic–derived left ventricular geometric patterns defined as concentric remodeling (CR), concentric hypertrophy (CH), and eccentric hypertrophy (EH). Methods: We analyzed data from the Jackson Heart Study, a community-based AA cohort who completed a baseline exam that included clinic blood pressure (CBP) and 2D echocardiography (n=5,301). CR, CH, EH, and normal patterns were defined according to left ventricular mass index and relative wall thickness defined using standard American Society of Echocardiography recommendations. The analysis was restricted to 4,572 participants with complete CBP, information on antihypertensive medication, and echocardiographic data. Results: Mean ± SD age was 55.5 ± 12.7 years; 64% were female. Mean ± SD systolic and diastolic CBP was 127 ± 18 and 79 ± 11 mmHg, respectively; 2,785 (61%) of participants had hypertension (CBP ≥140/90 mmHg and/or taking antihypertensive medications). The prevalence of CR, CH, and EH were 10.1%, 5.2%, and 8.2%, respectively. In a multivariable-adjusted model with a normal pattern as the referent group, hypertension was associated with a greater risk of CR, CH, and EH: odds ratio 1.85 (95% confidence interval (CI) 1.43-2.38), 4.16 (95% CI 2.53-6.86), and 1.67 (95% CI: 1.26-2.23) respectively. Among hypertensive participants, older age was significantly associated with CR, CH, and EH after multivariable adjustment. Higher systolic CBP, current smoking and a higher number of classes of antihypertensive medications were additionally significantly associated with CH and EH. Male sex, and heavy and moderate alcohol consumption versus none were also significantly associated with CR. Conclusions: In conclusion, abnormal left ventricular geometry was present in almost 25% of AAs. Hypertension was associated with each abnormal geometric pattern, with approximately a four-fold greater odds for CH. Future studies should examine whether abnormal left ventricular geometric patterns, particularly CH, explains the increased risk of cardiovascular disease outcomes associated with hypertension in AAs.

Abstract P175: Can Pediatric Hypertension Criteria be Simplified? A Prediction Analysis of Subclinical Cardiovascular Outcomes From the Bogalusa Heart Study

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Bo Xi ◽  
Tao Zhang ◽  
Shengxu Li ◽  
Wei Shen ◽  
Emily Harville ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Left Ventricular Hypertrophy ◽  
Ventricular Hypertrophy ◽  
Characteristic Curve ◽  
Later Life ◽  
Left Ventricular ◽  
Pediatric Hypertension ◽  
Bogalusa Heart Study ◽  
Heart Study ◽  
Subclinical Cardiovascular Disease

Background: Pre-hypertension and hypertension in childhood are defined by sex-, age- and height-specific 90th (or ≥120/80 mmHg) and 95th percentiles of blood pressure (BP), respectively, by the 2004 Fourth Report. However, these cut-offs are complex and cumbersome for use. This study assessed the performance of a simplified BP definition to predict adult hypertension and subclinical cardiovascular disease. Methods: The longitudinal cohort consisted of 1,225 adults (530 males, aged 26.3–47.7 years) from the Bogalusa Heart Study, with 27.1 years follow-up since childhood. We used 110/70 and 120/80 mmHg for children (age 6-11 years), and 120/80 and 130/85 mmHg for adolescents (age 12-17 years) as the simplified definitions of childhood pre-hypertension and hypertension, respectively, to compare with the complex definitions. Adult carotid intima-media thickness (CIMT), pulse wave velocity (PWV), and left ventricular mass were measured using digital ultrasound instruments. High CIMT was defined as being above the age-, gender- and race-specific 80th percentile, high PWV as being above the age-, gender-, race- and heart rate-specific 80th percentile and left ventricular hypertrophy as >46.7 g/m 2.7 in women and >49.2 g/m 2.7 in men. Results: Compared to normal BP, childhood hypertensives diagnosed by the simplified definition (4.1%, 50/1,225) and the complex definition (4.8%, 59/1,225) were both at higher risk of adult hypertension with hazard ratio=3.1 (95% confidence interval=1.8-5.3) by the simplified definition and 3.2 (2.0-5.0) by the complex definition, high PWV with 3.5 (1.7-7.1) and 2.2 (1.2-4.1), high CIMT with 3.1 (1.7-5.6) and 2.0 (1.2-3.6), and left ventricular hypertrophy with 3.4 (1.7-6.8) and 3.0 (1.6-5.6). The prediction using the two childhood BP definitions for adult hypertension and subclinical cardiovascular disease was also assessed by reclassification or receiver operating characteristic curve analyses. Conclusions: The simplified childhood BP definition predicts the risk of adult hypertension and subclinical cardiovascular disease equally as the complex definition does. The simplified pediatric BP cut-offs could be easier to use for screening children at high risk and for targeting early life interventions to reduce the risk of developing cardiovascular disease in later life.

Abstract MP65: Masked Hypertension is Associated with Cardiovascular Disease Events in African Americans: The Jackson Heart Study

Circulation ◽  
2016 ◽  
Vol 133 (suppl_1) ◽  
Author(s):  
John N Booth ◽  
Keith M Diaz ◽  
Samantha Seals ◽  
Mario Sims ◽  
Joseph Ravenell ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Cardiovascular Disease ◽  
African Americans ◽  
Blood Pressure Monitoring ◽  
Masked Hypertension ◽  
Jackson Heart Study ◽  
Cvd Risk ◽  
Nocturnal Hypertension ◽  
Heart Study ◽  
All Cause Mortality

Introduction: Masked hypertension has been associated with increased cardiovascular disease (CVD) risk in Europeans and Asians. Hypothesis: Determine the association of masked hypertension with CVD events and all-cause mortality in African Americans (AA). Methods: The Jackson Heart Study, an exclusively AA population-based, prospective cohort study, was restricted to participants with clinic systolic/diastolic blood pressure (SBP/DBP) < 140/90 mmHg and valid ambulatory blood pressure monitoring (ABPM) at the baseline exam in 2000-2004 (n=738). Masked daytime hypertension was defined as mean ambulatory daytime (10am-8pm) SBP ≥ 135 mmHg or DBP ≥ 85 mmHg. Masked nocturnal hypertension was defined as mean ambulatory nighttime (12am-6am) SBP ≥ 120 mmHg or DBP ≥ 70 mmHg. Using all ABPM measurements, masked 24-hour hypertension was defined as mean SBP ≥ 130 mmHg or DBP ≥ 80 mmHg. CVD events (nonfatal/fatal stroke, nonfatal myocardial infarction or fatal coronary heart disease) and all-cause mortality were identified and adjudicated through December 31, 2011. Results: Any masked hypertension (masked daytime, nocturnal or 24-hour hypertension) was present in 52.2% of participants; 28.2% had masked daytime hypertension, 48.2% had masked nocturnal hypertension and 31.7% had masked 24-hour hypertension. There were 51 CVD events and 44 deaths over a median follow up of 8.2 and 8.5 years, respectively. The CVD rate (95% CI) per 1,000 person years in participants with and without any masked hypertension were 13.5 (9.9-18.4) and 3.9 (2.2-7.1), respectively (Table). The multivariable adjusted hazard ratio (95% CI) between any masked hypertension and CVD was 2.49 (1.26-4.93). CVD rates for those with and without masked daytime, nocturnal and 24-hour hypertension, and the hazard ratios for CVD associated with masked daytime, nocturnal and 24-hour hypertension, were similar. Masked hypertension was not associated with all-cause mortality. Conclusion: Masked hypertension is common and associated with increased CVD risk in AAs.

Abstract P345: Prediction of Cardiovascular Disease Events and Death using Multiple Biomarkers in African Americans: the Jackson Heart Study

Circulation ◽  
2014 ◽  
Vol 129 (suppl_1) ◽  
Author(s):  
Solomon K Musani ◽  
Ramachandran Vasan ◽  
Aurelian Bidulescu ◽  
Jung Lee ◽  
Gregory Wilson ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
African Americans ◽  
High Sensitivity ◽  
Serum Cortisol ◽  
Jackson Heart Study ◽  
Cvd Risk ◽  
Risk Reclassification ◽  
Heart Study ◽  
Traditional Risk Factors

Background: The usefulness of biomarkers from different biologic pathways for predicting cardiovascular disease (CVD) events among African Americans is not well understood. Methods: We evaluated prospectively 3,102 Jackson Heart Study participants (mean age 54 years; 64% women) with data on a panel of 9 biomarkers representing inflammation (high sensitivity C - reactive protein), adiposity (adiponectin, leptin), neurohormonal activation (B-type natriuretic peptide [BNP], aldosterone, and cortisol); insulin resistance (HOMA-IR); and endothelial function (endothelin and homocysteine). We used Cox proportional hazard regression to relate the biomarker panel to the incidence of CVD (stroke, coronary heart disease, angina, heart failure and intermittent claudication) adjusting for standard CVD risk factors. Results: On follow-up (median 8.2 years), 224 participants (141 women) experienced a first CVD event, and 238 (140 women) died. Circulating concentrations of aldosterone, BNP and HOMA-IR were associated with CVD (multivariable-adjusted hazard ratios [HR] and 95% confidence interval [CI] per standard deviation (SD) increase in log-biomarker) were, respectively 1.15, (95% CI 1.01-1.30, p=0.016), 1.97, (95% CI 1.22-2.41, p<0.0001), and 1.30, (95% CI 1.10-1.52, p=0.0064). Blood cortisol and homocysteine were associated with death (HR per SD increment log-biomarker, respectively, 1.17, (95% CI 1.01-1.35, p=0.042), and 1.24, (95% CI 1.10-1.40, pvalue=0.0005). Biomarkers improved risk reclassification by 0.135; 0.120 of which was gained in classification of participants that experienced CVD events and 0.015 from participants that did not. Also, biomarkers marginally increased the model c-statistic beyond traditional risk factors. Conclusions: In our community-based sample of African Americans, circulating aldosterone, BNP and HOMA-IR predicted CVD risk, whereas serum cortisol and homocysteine predicted death. However, the incremental yield of biomarkers over traditional risk factors for risk prediction was minimal.

Mo-P2:196 A genome scan for subclinical cardiovascular disease in the diabetes heart study

2006 ◽  
Vol 7 (3) ◽  
pp. 89
Author(s):  
D.W. Bowden ◽  
A.B. Lehtinen ◽  
J.T. Ziegler ◽  
D. Herrington ◽  
L.E. Wagenknecht ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Genome Scan ◽  
Heart Study ◽  
A Genome ◽  
Subclinical Cardiovascular Disease ◽  
Diabetes Heart Study
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